What Role Do DSM-5 Criteria For Substance Use And Addictive Disorders Play In Addiction Diagnoses?

Addiction is an insidious disease, one that may start with a series of choices but then hijacks the brain — and depending on what you're addicted to, sometimes the body, too. Once you're in the claws of an addiction, that all-encompassing call for more drugs, more alcohol, more gambling, more shopping, more food, more sex, or whatever it is you are addicted to, becomes almost impossible to turn down. 

The American Society of Addiction Medicine describes addiction as a chronic and often progressive disease that may feature periods of remission and relapse. We know, now, that becoming an addict isn't a moral failing or a continuous choice. Once you're addicted, your addiction will have robbed you of a significant portion of control. 

That help starts with diagnosis, and in the US, clinicians will use the fifth edition of the diagnostic and statistical manual of mental disorders — the DSM-5 for short — to determine whether you are addicted, and how severely. 

What do addicts and their loved ones need to know about the DSM-5 diagnostic criteria for addiction?

The DSM-5 is an incredibly long document filled with diagnostic criteria for numerous different mental and cognitive disorders, ranging from depression to autism spectrum disorder, and schizophrenia to narcissistic personality disorder. Addiction is covered in a chapter on substance-related and addictive disorders. The chapter features numerous different addictions, including alcohol, tobacco, opioids, sedatives, hypnotics, cannabis, and even caffeine. It also includes gambling, but is top-heavy on substance addictions and rather devoid of behavioral addictions. 

The DSM-5 includes those addictions that were backed by solid science at the time of publishing. Not all addictions described in the medical literature — such as addictions to food, shopping, sex, gaming, and internet use — are official diagnostic categories within the DSM-5. If you (believe you) are addicted to something not covered in this document, you can still receive the help you need. If something's not in the DSM-5, it doesn't mean it doesn't exist.

A look at the diagnostic criteria for addiction

First off, the DSM-5 will require at least two of the symptoms to be present within a single year, leading to significant distress or impairment:

• The person uses more of the substance, or for longer, than they had planned. 
• The person wants to cut down or stop using the substance, but is unsuccessful in these efforts. 
• The person spends large amounts of time using the substance, obtaining it, or recovering from its use. 
• The person experiences strong cravings for the substance.
• Using the substance causes the person to not meet their important responsibilities in life. 
• The substance use causes interpersonal problems or makes them worse, but this does not lead the person to cut down or stop. 
• The person misses out on important events because of their substance abuse. 
• The person uses the substance in situations where it is physically dangerous (such as while driving or operating heavy machinery). 

Then, there is tolerance — the person no longer achieves the same effect from using the same amount (or, in the case of a behavioral addiction, for instance, gambling the same amount of money), or begins to use more to get back to that same effect. Finally, there is withdrawal — the person experiences the withdrawal symptoms associated with the substance in question when they attempt to stop using the substance. 

You also need to know that:

• When someone is diagnosed with an addiction, the clinician specifies how severe it is. Having two or three of these symptoms generally points to a milder addiction, having four or five points to a moderately severe addiction, and a severe addiction is marked by six or more of the symptoms.
• If you have used within the last year but not in the last three months, you may be diagnosed as being in "early remission". If you previously met the diagnostic criteria for any addiction but have been abstinent for longer than a year, you are in sustained remission. 

Should you believe you have an alcohol use disorder (alcoholism) and approach your family doctor about it, for instance, they may start with questions such as:

• How much do you drink, and how often?
• How often do you feel guilt or remorse after drinking?
• Do you ever drink first-thing in the morning to be functional?
• How often have you not been able to do what's expected of you because you were drinking?
• Has a relative or doctor expressed concern about your drinking?
• Have you ever been injured because you were drinking? Has someone else?

These kinds of questions ultimately seek to determine if you meet the diagnostic criteria, but in more practical and concrete terms. 

Determining if you are an addict, and how severely you're addicted, is just a first step — often, a very scary first step. It is, however, the step that will allow addicts to receive the help they need to achieve remission.